ASSOCIATIONS BETWEEN DIAGNOSES, IMPAIRMENTS, DISABILITY AND HANDICAP IN A POPULATION OF ELDERLY PEOPLE

Background 'Handicap' is the disadvantage for an individual that resul ts from ill-health. It represents an important outcome in chronic disa bling disease, but has proved difficult to measure until recently. The strength of association between handicap and other health Status meas ures, and the relative contributions of health and socioeconomic varia bles to handicap have not been studied previously. Methods We undertoo k a cross-sectional survey of all people >65 years old in a defined ge ographical area of North London. The interview was based on the short- CARE psychiatric survey tool, and in addition included measures of phy sical health and disability, the London Handicap Scale, income, social support and housing. In all, 654 residents (74%) from a register of 8 89 were interviewed. A random sample of 225 had additional data collec ted which are reported in this analysis. Results Strength of associati on with handicap scores increased progressively from diagnosis to impa irment to disability. Variation in handicap with diagnosis was explain ed by impairment, and variation with impairment was mostly explained b y disability. Age, housing quality, social support and income were ass ociated with handicap score, but confounding by these did not explain the association between handicap and other aspects of disablement. Dis ease-associated variables explained quantitatively much more variation in handicap than socioeconomic variables. Conclusions The most potent influences on handicap are disease and disability, justifying the hig h priority given by health services to detection, treatment and rehabi litation. Where this is not possible handicap may be reduced to some e xtent through socioeconomic intervention.